Objective: To evaluate the correlation of high-resolution computed tomography-based radiological predictors with the surgical ease of access to the round window membrane in cochlear implant surgery. Method: The systematic review was conducted from April 2020 to May 2020 at the Aga Khan University Hospital, Karachi, and comprised literature search on PubMed, Cumulative Index of Nursing and Allied Health Literature- Plus, Wiley Cochrane Library and Web of Science databases for studies published in the English language between January 2000 and January 2020 that followed the population-intervention-comparison-outcome model. The search was done using key words, such as high-resolution computed tomography, temporal bone, round window and cochleostomy. Studies dealing with paediatric and adult cochlear implantations were included. The included studies were subjected to risk-ofbias assessment using the National Institute of Health study quality assessment tool for case series. The review was duly registered with PROSPERO. Results: Of the 292 studies initially identified, 6(2%) were included for systematic review. Overall patient age ranged between 1-85 years. No significant use of facial recess width for defining intraoperative visibility could be found. The use of the distance between the round window and the facial nerve, the alpha angle, the angle beta and the prediction line were of significance. Conclusion: Radiological facial recess width had no significant use in determining the ease of access to the round window membrane. Keywords: Cochlear implants, Temporal bone, Round window, Middle ear, CT scan temporal bone. PROSPERO ID registration link: https://www.crd.york. ac.uk/PROSPERO/view/CRD420261302451.

Objective: To assess the frequency and causes of unplanned readmissions and emergency department visits of patients having undergone head and neck surgeries within 30 days of the initial surgery. Method: The cross-sectional, retrospective study was conducted at the Department of Otolaryngology and Head and Neck Surgery, Aga Khan University Hospital, Karachi, from January 2020 to June 2020 and comprised data from January 2017 to December 2019 of all patients who underwent head and neck surgery. Data was collected using a customised proforma and was analysed using SPSS 23. Results: Against 1,094 admissions, there were 142(12.97%) readmissions. Of them, 7(4.9%) were excluded due to missing data. Among the remaining 135(95.1%) subjects, 86(64%) were male and 49(36%) were females. The overall mean age was 51.1± 15.634 years. Most of the patients 82(61%) were admitted to the emergency department, Oral carcinoma was the most common primary diagnosis 89(66%), and 82(61%) of the readmitted patients were admitted through ED. There were 28(21%) patients readmitted with haemorrhage, while 63(47%) required nonsurgical treatment on readmission. Conclusion: Total rate of unplanned readmission in head and neck surgeries within 30 days was 12.97%, with bleeding and infection being the most common causes of readmission. Key Words: Patient readmissions, 30-day readmissions, Head and neck cancer, Head and neck surgery, Postoperative readmission.

Background Submental artery island flap is a pedicled regional flap which is used as one of the quicker reconstructive options for oral cavity defects. However, concerns about its oncological safety have been raised due to the proximity of the submental lymph nodes, which may harbor metastatic deposits. This study aimed to systematically evaluate the oncological safety of the SAIF oral cavity reconstruction.Methods A systematic review and meta-analysis was conducted according to the PICO model. Studies were included if they assessed the oncological safety of the SAIF in oral cavity reconstruction.Results The use of SAIF for oral cavity reconstruction appears to provide reasonable oncological safety in terms of locoregional recurrence. The overall pooled recurrence rate across the studies was 16% (95% CI: 14%-18%).Conclusion This systematic review demonstrates that the submental artery island flap is an oncologically safe and reliable reconstructive option for oral cavity defects following OSCC resection in carefully selected patients.

Objective: To investigate the prevalence, utilisation and association of diagnostic delay, tumour stage and recurrence with alternative medicine among head and neck cancer patients having undergone surgical resection. Method: The retrospective, cross-sectional study was conducted from March to June 2024 at the Department of Otolaryngology and Head and Neck Surgery, Aga Khan University Hospital, Karachi, and comprised adult patients who underwent surgical resection of primary head and neck cancers from January 1, 2017, to January 31, 2019. Data was collected from the patient electronic medical records related to tumour characteristics along with details regarding treatment and exposure to alternative therapy. Data was analysed using SPSS 23. Results: Of the 125 patients with mean age 46.71±12.6 years, 98(78.4%) were male and 27(21.6%) were female. Overall, 33(26.4%) patients reported AM exposure. Most patients presented with advanced-stage disease 98(83.4%), and 28(28.6%) of them had sought alternative treatments prior to conventional medical care. Majority of patients had an undergraduate education 92(86.6%), were minimum wage earners 114(91.2%), and an early recurrence was noted in 59(47%) cases. There was no significant difference with respect to cancer stage, levels of education and income, and recurrence rate between those who sought alternative medicine and thoe who did not (p>0.05). Conclusion: A significant number of oral cancer patients had utilised alternative medicine. However, the practice was not correlated with disease severity, socioeconomic status or disease recurrence. Key Words: Complementary therapy, Traditional healers, Delayed diagnosis, Recurrence, Herbal medicine.

Bronchogenic cysts are congenital cystic lesions arising as aberrant budding from primordial lung buds in the early stage of foregut development with a worldwide prevalence of 6

Jugular vein phlebectasia (JVP) refers to fusiform, non-tortuous distention of a portion of vein, two to three times its usual size, first addressed by Harris in 1928. It is classically considered a rare benign structural anomaly, with only 247 cases reported. Internal jugular vein is affected in most cases of phlebectasia in head and neck region; it is frequently observed on right side probably due to favorable anatomical features such as larger right internal jugular bulbs, shorter course of right brachiocephalic vein, direct emptying into the superior vena cava, and the close proximity of right innominate vein to the apical pleura, therefore risking the right IJV as the intrathoracic pressure rises. It presents as a soft, compressible, and painless swelling over the lateral neck, briefly emerging with augmented intrathoracic pressure, like during coughing, straining or performing Valsalva. Treatment strategy is usually conservative. A 7-year-old male child presented with complaint of intermittent left sided neck swelling, noticed by parents when the child cries or shouts and disappears afterward. X-ray neck was done which came normal with no unusual air shadow. CT scan reported fusiform ectasia of left internal jugular vein in neck at the level of thyroid gland, about 1.6 × 2.7 × 4.8 cm in size with the diagnosis of “phlebectasia.” This case report unveils an extremely rare occurrence of phlebectasia that typically affects children and on the right side of the neck, by presenting on the left side, highlighting the unpredictable nature of this already uncommon condition in Asia.

Solitary fibrous tumors (SFTs) belonging to a distinct group of mesenchymal tumors, was originally described by Klemper and Rabin in the pleura in year 1931. However, it can also be extra-pleural in origin. With tongue being the most common site involved in this region, epiglottis, larynx, thyroid, external auditory canal, lacrimal sac, hypoglossal nerve, parotid gland, sublingual gland, Para pharyngeal space, nasopharynx, scalp, gingiva, orbit and infratemporal fossa as well as paranasal sinuses and nasal cavities can also get involved. But SFTs involving nasal cavities and nasopharynx are quite uncommon, accounting for < 0.1% of all Sino-nasal neoplasms. Until now there have only been 40 cases of nasal SFT reported in literature. We report the case of an extraserosa solitary fibrous tumor arising from the nasal cavity with extension to the sphenoid sinus, a much rarer presentation of its type. Our case report is one of its type, emphasizing the need conducting further studies on the nature and management of the disease.

Background Tracheostomy is considered the oldest and the most effective operative procedure for patients admitted to intensive care units and in emergencies. The study’s objective was to evaluate healthcare providers’ knowledge regarding tracheostomy care. Results All healthcare professionals directly involved in the provision of care to patients with tracheostomy were included and asked to fill out the questionnaire. The response rate was 87.63%. Out of 50, the mean comfort score was 37.69. 70.6% of participants reported having a comfort score equal to or more than 70%. Out of 10, the mean score was 5.29. Only 20.9% of participants were able to score equal to or more than 70%. The results demonstrate that healthcare professionals’ knowledge of tracheostomy care was below par. Only those who were experienced in this field were able to score above average. Conclusion The assessment of knowledge in tracheostomy care highlights the significance of ongoing education and training in the healthcare field. As medical practices evolve, it is imperative for healthcare providers to stay updated with the latest guidelines and techniques to provide the highest standard of care.

Non-recurrent laryngeal nerve (NRLN) is an anatomic variation seen in about 0.52-0.7% patients, generally on right side. It exits the vagus nerve having a direct route to the larynx, unlike usual recurrent laryngeal nerve, supplying intrinsic laryngeal muscles except cricothyroid. It is sited over left side on extremely rare occasions, that is, 0.04% of the cases. Some cases of NRLN co-exists with aberrant right subclavian artery which courses behind the esophagus, also known as 'arteria lusoria'. Here we present a case of 60-years old patient, diagnosed as goiter presented to us in june 2023 at the department of head and neck surgery at a tertiary care setup of Karachi Pakistan. Intra-operatively, non-recurrent nerve was encountered, whose association was found with arteria lusoria, observed in pre-operative CT-scan. The nerve was saved and no post-operative complications were seen in patient. The association of arteria lusoria in this case emphasize its importance in predicting NRLN via pre-operative imaging techniques which can prevent its injury intra-operatively.

Human body has a set of unspecialized cells called as stem cells that have the ability to generate cells of specialized function. Volume of fractionated plasma extracted from autologous blood is termed as Platelet-rich plasma (PRP) that is rich in several growth factors. Both have shown effective results in the field of regenerative medicine. Physiologically, platelets are the first cells to concentrate at the site of tissue damage, therefore application of PRP in diverse surgical procedures enhances bone and soft tissue healing; this same phenomenon is currently being used in otology, head and neck flap surgery and yielding miraculous outcomes. The perspective role of stem cells in regenerative medicine is wrapped in its loosely arranged DNA with working genes; a similar concept is being worked upon in different ENT procedures with groundbreaking results. But still, the data is scarce and there is a dire need for clinical trials, and large population-level studies to further formulate the guidelines on basis of proven evidence.

Papillary thyroid carcinoma is the most prevalent endocrine malignancy of the head and neck region. It makes up to 80% of all thyroid cancers, and has a 10-year survival rate of up to 95%. Differentiated thyroid carcinomas have good prognosis after a complete surgical extirpation as long as it is not associated with invasion of the surrounding structures. The advanced papillary thyroid carcinoma can invade the neighbouring structures of the thyroid gland, such as strap muscles, recurrent laryngeal nerve, trachea, oesophagus, larynx, pharynx, and carotids. Whenever papillary thyroid carcinoma is associated with invasion of aerodigestive tract it is difficult to excise the tumour. We report a patient with stage IV invasive papillary thyroid carcinomas as per Shin Staging system. The surgery was deferred from several hospitals considering the advanced stage of the disease with tracheal extension making it a problematic airway for both the anaesthesiologist and the operating surgeon. The patient underwent total thyroidectomy, modified radical neck dissection, tracheal resection, and primary anastomosis. Successful intubation was done with video laryngoscopy. Intermittent apnoea technique was used for ventilation during the repair of posterior tracheal wall. The patient was extubated on the table and shifted to the recovery room. The histopathologic diagnosis was reported as papillary thyroid carcinoma classic variant with tracheal invasion.

Introduction Thyroid nodules are common globally in almost one fifth of the adult population. The gold standard treatment for thyroid nodule is thyroid lobectomy or total thyroidectomy depending upon the diagnosis. Thyroidectomy has a few known complications but, as per the ATA consensus statement, it is a safe surgery to be done as a day care procedure. Objective To access the feasibility and safety of thyroid lobectomy as a day care surgery and its effect on decreasing overall financial burdens. Methods This retrospective chart review was done from 2006 to 2022. A total of 736 patients underwent thyroid lobectomy among which only 56 were done as day care surgery. Data analysis was done using the IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., Armonk, NY, USA). Results A total of 40% of the population was male. The mean age of the study population was 42 years. Bethesda II was the most encountered diagnosis, with a rate of 69%. The majority of patients were discharged after 6 hours of postoperative observation. The only complication encountered was seroma, which was seen in two patients. Conclusion Thyroid lobectomy appears to be a safe procedure with a drastic difference in overall cost as a day care procedure. We recommend switching the practice of inpatient thyroid lobectomy to a day care procedure in carefully selected candidates. The major hurdle in day care lobectomy can be approval from insurance.

Pierre Robin Sequence (PRS), a rare congenital disorder, is a triad of micrognathia, glossoptosis, and tongue based airway obstruction (TBSO). It may occur as isolated anomaly (iPRS) or as a part of a syndrome (sPRS), like that seen in association with Stickler Syndrome. Approximately 20% of children with PRS have congenital heart diseases. To the best of our knowledge this case of a one-day old infant is the first one to be reported as having two heart defects; patent ductus arteriosus and patent foramen ovale in Pierre Robbin Sequence child.

Aberrant innominate artery lying high in the neck is a rare entity that can be encountered intraoperatively during midline neck surgeries such as thyroidectomy and tracheostomy. Surgeons should be mindful of this entity as injury to the artery can lead to life-threatening haemorrhage. We report a case of a 40 year old female in whom an aberrant innominate artery was identified high in the neck, while performing a total thyroidectomy.

Background:Skeletal dysplasia's cause significant neurological symptoms and disrupt the development of many bones and cartilages in the body. Skeletal dysplasia, although a common presentation in paediatric population, rarely presents in older age group.Case presentation:This case presents a unique incidental finding of skeletal dysplasia in a fifty-year-old male patient who presented with osteoarthritis. Eventual workup uncloaked the presence of cleidocranial dysplasia and spondyloepiphyseal dysplasia. The patient in this case had both dysplasias at the same time.Discussion:Cleidocranial dysplasia and Spondyloepiphyseal dysplasia are two uncommon autosomal dominant dysplasia's that are often diagnosed in early life and can have serious consequences, including death. It is critical to diagnose a child early in life. Radiology findings from a thorough skeletal examination aid in the early detection of numerous dysplasia's, which helps improving quality of life and allowing for effective treatment.Conclusion:The novelty of our presented case lies in the rare presentation of CCD and SED occurring concurrently at an older age with accompanying collateral abnormalities usually emerging more commonly in infants. Early diagnosis is thus essential for optimal management.

Background and objective Head and neck cancers are prevalent in Pakistan. Oral squamous cell carcinomas are primarily treated via surgical removal, and complete surgical resection is the paramount prognostic factor. A resection margin of 5 mm on the final histopathology report has been accepted as adequate in the existing literature. Negative margins on the frozen section do not guarantee adequate disease-free resections on the final histopathology report. In this study, we aimed to ascertain how accurately tumor-free margins can be detected on frozen sections, which are reported intraoperatively compared to permanent sections of the same tissues reported after proper staining in oral squamous cell carcinoma patients. Methods A cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan; 94 patients presenting between January and October 2016 were included in this study and a total of 432 tumor margins were assessed. Results Among the total 94 patients included in the study, 79% were male and 21% were female. Buccal mucosa was the most commonly involved subsite (57%), followed by the tongue (25%). The most common T stage was T4 (33%), followed by T2 and T3 at 28% and 21% respectively, while the most common N stage was N0 (55%) followed by N1 at 16% and N2 at 22%. The sensitivity of the frozen section in comparison to the permanent section was found to be 50%, while specificity was calculated to be 99.8%. The positive predictive value was 75% and the negative predictive value was 99.3%. Conclusion The frozen section is a highly useful tool for the evaluation of tumor margins. However, while it has high diagnostic accuracy rates, it can produce altered results and therefore requires high clinical correlation.

Introduction Management of the thyroid gland during laryngectomy has been controversial. The primary tumor may invade the thyroid gland by direct invasion or lymphovascular spread. Hypothyroidism and hypoparathyroidism are potential risks when lobectomy or total thyroidectomy are performed simultaneously. Objective To report the frequency of thyroid gland involvement by primary laryngeal squamous cell carcinoma in patients undergoing laryngectomy and to identify possible risk factors for thyroid gland involvement so that judicious excision of thyroid gland can be attained. Methods We performed a retrospective review of 9 years. Data was collected from medical records of patients dated from December 2009 to October 2018. All patients with laryngeal cancer who underwent laryngectomy with lobectomy or total thyroidectomy were included in the present study. Results We reviewed 151 laryngectomy records. A total of 130 surgeries included the thyroid gland with the excised specimen and were available for analysis. There were 124 males and 6 females. The mean age was 59.4 years old. The glottis was the most common subsite involved, in 70 patients, followed by 38 transglottic, 16 supraglottic and 03 subglottic tumors. On histology, 12 out of 130 excised thyroid glands were involved by squamous cell carcinoma. Only subglottic involvement (p = 0.01) was significantly associated with thyroid gland invasion (TGI). Type of laryngectomy, subsite of the primary tumor, thyroid cartilage involvement, neck nodal metastases, and perineural and lymphatic invasion by the primary tumor were not associated with TGI. Conclusion Only subglottic involvement is associated with TGI; therefore, preoperative and intraoperative assessment is necessary prior to considering excision of the thyroid gland.

OBJECTIVE:To see the rate of publication of postgraduate residents' dissertation.METHODS:The single-centre retrospective cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, and comprised research publications from the residents of the departments of Surgery and Medicine who graduated between 2005 and 2020. The surgical subspecialties included Otolaryngology, Ophthalmology, Dentistry, General Surgery, Orthopaedics, Paediatric Surgery, Urology, Plastic Surgery and Cardiovascular Surgery. Data comprised demographics, current institution, current designation, information on dissertation/paper publication, topic of study, year of completion of dissertation, input from the research department, delay in exam due to incomplete dissertation and whether the paper got published in national or international journal. Data was analysed using SPSS 21.RESULTS:Of the 103 subjects, 70(68%) were males and 33(32%) were females, while 73(70.8%) belonged to surgical specialties and 30(29.2%) were from non-surgical specialties. Of the 22(22.9%) who were able to convert, 12(54.5%) publications were carried by national peer-reviewed journals, while 10(45.4%) were carried by international journals; 9(40.9%) unpaid peer review journals and 13(59.1%) paid journals. Delay in exam due to incomplete dissertation was faced by only 16(16.6%) candidates.CONCLUSIONS:The rate of publication for resident dissertation was found to be low.

Coronavirus disease 2019 (COVID-19) has emerged as an unforeseen challenge for head and neck cancer care providers. A similar challenge is also faced by other oncological fields, but the severity of this challenge is highest in otolaryngology because of the need for additional precautionary measures and curbs on the possibility of aerosol forming interventions related to the upper aerodigestive tract. In this narrative review, provision of ethical and consistent care on moral and professional grounds to head and neck cancer patients during the pandemic are discussed for professionals who provide head and neck oncology care.

OBJECTIVE:To determine the association between site and size of perforation of the tympanic membrane and the level of conductive hearing.METHODS:The cross-sectional study was conducted from November 2015 to October 2016 at Aga Khan University Hospital Karachi and comprised patients with tympanic membrane perforation without any other middle-ear disease. Karl-Storz Rigid Endoscope attached to a camera was used to take pictures of the tympanic membrane. Site of the perforation was determined using a vertical line to divide the membrane into two anterior and posterior halves. Size of the perforation was calculated as a percentage of the total membrane using Image J software. Data analysis was done using Stata 12.RESULTS:Of the 55 patients, 29(53%) were males and 26(47%) were females. The overall mean age was 33+/-15 years. With every 5% increase in the size of perforation, the hearing loss increased by 1 decibel. A difference of 5.5 decibels was noted between anterior and posterior perforations of similar size.CONCLUSION:Hearing loss increased with increase in the size of perforation.